Tivon Isaac Sidorsky, MD, MBA, FAAD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

258818 Issued in MA

Practice address

1 Scobee Cir Ste 3
Plymouth, MA 02360-4887

Phone

(508) 747-0711

NPI assigned

May 6, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Geisel School of Medicine at Dartmouth, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Dermatology Associates PCGroup PAC ID 3072403799, 84 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: drsidorsky@southshoreskin.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Dermatology Associates, PC

  • Specialist
  • North Andover, MA
  • NPI 1104921162
  Medicare reassignment Care Compare group NPD
• South Shore Skin Center, LLC

  • Specialist
  • Plymouth, MA
  • NPI 1790763159
  Medicare reassignment NPD
• Neda at North Shore PC

  • Dermatology Physician
  • Marblehead, MA
  • NPI 1902345861
  NPD
• Nedas LLC

  • Dermatology Physician
  • North Andover, MA
  • NPI 1043683923
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426118400000",
    "number": "1285952846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SCOBEE CIR STE 3",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023604887",
            "telephone_number": "508-747-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SCOBEE CIR STE 3",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023604887",
            "telephone_number": "508-747-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDORSKY",
        "first_name": "TIVON",
        "middle_name": "ISAAC",
        "name_prefix": "Dr.",
        "credential": "MD, MBA, FAAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-06",
        "last_updated": "2015-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "258818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Showstead
• Conrad Shultz, LADC
• Ashley Brooke Shute, MSW
• Madhu Siddeswarappa, M.D
• Allison Siden
• Corey Signs, CNM
• Carol Ann Silva, LICSW
• Harley Silva
• Ildivina Silva
• Mark Vicente Silva, M.D.

• Dermatology Physician in Plymouth, MA
• Providers in Plymouth, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.